Provider Demographics
NPI:1225540768
Name:LUCAS FLYNN DC LLC
Entity Type:Organization
Organization Name:LUCAS FLYNN DC LLC
Other - Org Name:VILLAGE SQUARE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-836-5000
Mailing Address - Street 1:55 SHIAWASSEE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3700
Mailing Address - Country:US
Mailing Address - Phone:330-836-5000
Mailing Address - Fax:330-836-5015
Practice Address - Street 1:55 SHIAWASSEE AVE STE 5
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3793
Practice Address - Country:US
Practice Address - Phone:330-836-5000
Practice Address - Fax:330-836-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty